DIAGNOSTIC 5 a. Upper outer portion of the thigh c.

Vastus lateralis
b. Upper outer portion of the gluteal muscle d. Right deltoid region
of the arm
SITUATION: The DOH developed and promotes various programs in
addressing major health problems. Nurse’s
7. It is known as the certification recognition program that develops
responsibility is in the implementation of these programs.
and promotes a standard for quality health care, services and
facilities.
1. Comprehensive postabortion care services should include both
a. FOURmula One b. EPI c. Sentrong Sigla d. Healthy
medical and preventive healthcare. The following except one are key
Lifestyle
elements of postabortion care:
a. Emergency treatment of incomplete abortion and potentially life-
8. Food establishments are already subject to sanitary inspection.
threatening complications
Which of the following are the four rights in food safety?
b. Postabortion family planning counseling and services
a. Right source, right preparation, right cooking, right storage
c. Links between postabortion emergency services and the
b. Right source, right temperature, right people, right amount
reproductive healthcare system
c. Right source, right preparation, right temperature, right storage
d. Psychological and spiritual counseling
d. Right source, right food handlers, right utensils, right preparation
2. WHO has identified the prompt treatment of incomplete abortion
9. There has been a steady increase in the number of household
as an essential element of obstetric care that should be available at
having access to safe water supply resources. The following are the
every district-level hospital. Emergency treatment for postabortion
approved types of water supply facilities by the DOH except:
complications does not include:
a. Point source b. Stand-posts c. Open dug wells d. Water works
a. Uterine evacuation to remove retained products of conception
system
(POC) c. Provision for family planning
b. An initial assessment to confirm the presence of abortion
10. Under the ENTREPRENURSE Project, unemployed nurses:
complications d. Prompt referral and transfer
a. Seek financial assistance from DOLE to organize a home health-
care cooperative under the supervision of a trained or experienced
3. A number of factors limit provision of family planning services to
nurse
women who have experienced an abortion. The following except
b. Can borrow money from the DOLE to start a health care related
one are factors that increase a woman's risk of repeated unwanted
business such as: Pharmacy store
pregnancies:
c. Can seek financial assistance when applying abroad
a. Lack of understanding of and attention to women's reproductive
d. Can work at any DOH hospital for 1 year with pay.
health needs on the part of providers
b. Lack of services for some groups of women
11. One of the essential elements of primary health care which
c. Misinformation among providers about appropriate postabortion
involves controlling all the factors in man’s environment that may
contraceptive methods
form links in disease transmission is:
d. Peer influences
a. Immunization c. Environmental sanitation
b. Treatment of locally endemic diseases d. Control of
4. Which of the following statements made by Nurse Hannah
communicable diseases
correctly describe the implementing rules and regulations of RA
9288?
12. Tuberculosis is considered as the world’s deadliest disease and
a. All communicable diseases should be reported to the nearest
remains as a major public health problem in the Philippines. Which
health station
statement is true regarding tuberculosis?
b. To acquire a marriage license, couple should receive instructions
a. The risk of developing the disease is low among adolescents
on family planning and responsible parenthood
b. A positive Mantoux Test indicates positive infection
c. Newborn screening should be performed after 24 hours following
c. Domiciliary treatment is the preferred mode of care
delivery of the newborn
d. Xray examinations alone is sufficient to make the diagnosis of TB
d. All children below 8 years of age requires compulsory
immunization against childhood immunizable diseases
13. Who among the following TB patients is included in Category 1
of treatment regimen?
5. A postpartum client asks the nurse, “What are the disorders
a. A patient who failed in the treatment c. New smear positive PTB
tested in newborn screening?” The nurse accurately responds by
b. Relapsed patient d. New smear-negative PTB with minimal
stating: a. “These are Congenital Hypothyroidism, Congenital
parenchymal lesions on CXR
Adrenal Hyperplasia, Galactosemia, PKU, and G6PD deficiency”
b. “These are Down syndrome, Cretinism, PKU and Galactosemia”
14. A child shall be clinically confirmed of having TB is he has three
c. “These are mental retardation, hypothyroidism, and PKU”
of the following conditions except one:
d. “All of the disorders known to man”
a. Positive history of exposure to an adult TB case c. Abnormal
chest radiograph suggestive of TB
6. School entrants are injected with BCG vaccine. The site of
administration is:
b. Positive tuberculin test d. Unexplained fever for 2 weeks or
more
15. Treatment regimen for children with PTB includes:
a. Intensive phase of Isoniazid, Rifampicin and Pyrazinamide for 2
months; Continuation phase of Isoniazid and
Rifampicin for 4 months
b. Intensive phase of Isoniazid, Rifampicin ,Pyrazinamide and
Ethambutol or Streptomycin for 2 months; Continuation
phase of Isoniazid and Rifampicin for 4 months
c. Intensive phase of Isoniazid, Rifampicin and Pyrazinamide for 4
months; Continuation phase of Isoniazid and
Rifampicin for 2 months
d. Intensive phase of Isoniazid, Rifampicin ,Pyrazinamide and
Ethambutol or Streptomycin for 4 months; Continuation
phase of Isoniazid and Rifampicin for 2 months
16. Rural sanitary inspectors and midwives compose what level of
primary health care workers?
a. Intermediate level health workers c. Grassroots health workers
b. Village health workers d. Barangay health workers
17. The core strategy of the Primary Health Care concept is
characterized by:
a. Partnership with the private sector c. Centralized delivery of
health care services
b. Essential health care services d. People empowerment
18. Community development advocates the principles of self-help
and the voluntary participation of the people of community.
Community development rests upon certain assumptions, this does
not include:
a. Everyone has something to contribute to the community
b. People have limited ability to learn
c. Community development provides the opportunity by which the
worth of an individual is revealed
d. Worth and dignity of individual are the basic values in a
democratic society
19. Mr. Tibe came to the health center clinic for his daily medication
for TB. This condition falls under:
a. Heath deficit b. Health threat c. Foreseeable crisis d. Stress
point
ANSWER: A
A health deficit occurs when there is a gap between actual and
achievable health status and occurs when there are instances of
failure in health maintenance. The presence of a disease falls under
this category:
Reference: Cuevas, Frances P., et. al. (2007) DOH’s Public health
nursing in the Philippines. 10th
edition, Page 44
20. These are conditions that promote disease or injury and prevent
people from realizing their health potential:
a. Heath deficit b. Health threat c. Foreseeable crisis d. Stress
point
SITUATION: Nurses today are actively generating, publishing and
applying research to be able to improve client care
and enhance nursing’s scientific knowledge base.
21. She is known as the first nurse researcher as well as the first
modern nurse.
a. Hildegard Peplau b. Martha Rogers c. Florence Nightingale d.
Callista Roy
22. The researcher may be guided by the following steps when doing
research studies:
1. Statement of the problem and hypothesis 3. Data collection
and methodology
2. Results, interpretation and conclusion 4. Theoretical
framework and definition of terms
a. 1,2,3,4 b. 1,4,3,2 c. 1,3,4,2 d. 1,2,4,3
23. Nurse Risa wants to study the effect of Metformin in lowering
glucose level among diabetic clients admitted at the hospital. The
independent variable is the:
a. Metformin b. Glucose level c. Diabetic clients d. Hospital
24. What is an example of a null hypothesis among the following
statements?
a. Students who enrolled in a review center will pass the NLE
b. The negative attitudes of the caregivers affect the help seeking
behavior of the patients
c. Exercise will lower the blood cholesterol
d. There is no significant relationship between smoking and glucose
level
25. If a researcher asks the subject to refer other potential subjects
as samples in the study. She is utilizing which
type of sampling:
a. Purposive sampling b. Snow-ball sampling c. Convenience
sampling d. Quota sampling
SITUATION: IMCI is a strategy developed by the World Health
Organisation and UNICEF. It has been introduced to address
morbidity and mortality in children.
26. A mother with her sick child comes to the health center. The
health worker should first:
a. Ask the mother about the child c. Check if the child’s weight and
temperature were recorded
b. Greet the mother appropriately d. Assess the child
27. After asking the mother what the child’s problems are, what is
the next thing that the nurse should do based on the IMCI?
a. Classify the condition b. Assess for main symptoms c. Check
for danger signs d. Refer the mother
28. The IMCI clinical guidelines focus on five main symptoms. Which
is not included?
a. Diarrhea b. Cough c. Ear Problems d. Constipation
SITUATION: Tuti is 11 months old. His temperature is 37.5 degree C.
His mother says he has had a dry cough for the last week. He has no
GDS. The health worker counted 42 bpm, does not see chest
indrawing and no stridor when
the he is calm. No visible severe wasting. There is some palmar
pallor. There is no edema of both feet.
29. Tuti’s sign is classified under:
a. VERY SEVERE MALNUTRITION OR VERY SEVERE ANEMIA c.
ANEMIA OR VERY LOW WEIGHT
b. SEVERE MALNUTRITION OR SEVERE ANEMIA d. NO ANEMIA AND
NOT VEY LOW WEIGHT
38. An infant is being treated for talipes equinovarus. Which
statement by the child’s mother indicates the best understanding of
the casting process?
a. “My child will have successive casts until the desired results are
achieved”
b. “Wearing cast is very painful, so I’ll need to medicate her every 4
hours”
c. “Once the cast is on, it will remain on until the deformity is
corrected”
d. “My child will be immobilized and confined to an infant seat”

30. Feeding recommendations for infants 6 months up to 12 months 39. A young child is admitted with acute epiglotittis. Which is of the
would include: highest priority as the nurse plans care?
a. Exclusive breastfeeding c. Breastfeeding plus lugaw with added a. Assessing the airway frequently c. Administering cough
pulverized roasted dilis medicine as ordered
b. Breastfeeding plus plain lugaw d. Breastfeeding plus adequate b. Turning, coughing, and deep breathing d. Encouraging the child
amounts family foods to eat

31. Signs of good attachment in breastfeeding include all but one: 40. A young child with high bronchial asthma is admitted for the
a. Mouth wide open c. More areola visible below than above second time in 1 month. Cystic fibrosis is suspected.
the mouth Which physiological assessment is most likely to be seen in the child
b. Chin touching the breast d. Lower lip turned outward with cystic fibrosis?
a. Expectoration of large amounts of thin, frothy mucus with
32. Leticia has measles and displays severe stomatitis with deep and coughing, and bubbling rhonchi for lung sounds
extensive mouth ulcers. This is classified as: b. High serum NaCl levels and low NaCl levels in the sweat
a. UNCOMPLICATED FEVER c. SEVERE COMPLICATED MEASLES c. Large, loose, foul-smelling stools with normal frequency or a
b. POSSIBLE BACTERIAL INFECTION d. MEASLES WITH MOUTH chronic diarrhea of unformed stools
COMPLICATIONS d. Obesity from malabsorption of fats and polycythemia from poor
oxygenation of tissues
33. Leticia’s classification is under which color?
a. Pink b. Red c. Yellow d. Green 41. Which finding would alert the nurse to potential problems in a
newly delivered term infant of a mother whose blood type is O
34. Clinical signs manifested by Leticia are as follows, except: negative?
a. Any danger sign b. Clouding of the cornea c. Deep Mouth a. Pallor c. Infant’s blood type is O negative
ulcers d. Pus draining from the eye b. Negative direct Coombs d. Resting heart rate is 155

35. IMCI recommends the following in soothing the throat and
relieving cough. Which is not included?
a. Calamansi b. Ginger c. Breastmilk d. Cough syrups
SITUATION: Today’s pediatric nurse faces an array of challenges in
providing care for children and their families. A nurse requires
competent skills form wide spectrum of both technological and
psychosocial disciplines.
36. Nurse Hannah is assessing a healthy neonate upon admission to
the nursery. Which characteristic would the admitting nurse record
as normal?
a. Hypertonia c. Head circumference measuring 31 cm
b. Irregular respiratory rate of 50 bpm d. High-pitched or shrill cry
37. The nurse is caring for a child with hemophilia who is actively
bleeding. Which nursing action is most important in the prevention
of the crippling effects of bleeding?
a. Active range of motion c. Encourage genetic counseling
b. Avoidance of all dental care d. Elevate and immobilize the
affected extremity
42. A 10-year old child is admitted to the hospital with sickle cell
crisis. Which client goal is most appropriate for this child?
a. The client will participate in daily aerobic exercises
b. The client will take an antibiotic until the temperature is within
normal limits
c. The client will increase fluid intake
d. The client will utilize cold compress to control pain
43. The nurse has been instructing the parents of a toddler about
nutrition. Which of the following statements best indicates the
parents’ understanding of an appropriate diet for a toddler?
a. “It’s unusual for a toddler to be a picky eater”
b. “A multivitamin each day will meet my child’s nutritional needs”
c. “Toddler needs servings from each food group daily”
d. “Toddlers should still be eating prepared junior foods”
44. A child has cerebral palsy and is hospitalized for corrective
surgery for muscle contractures. What is the most important
immediate postoperative goal?
a. Ambulate using adaptive devices c. Verbalize pain control
b. Demonstrate optimal oxygenation d. Complete daily self-care
needs

45. The nurse is teaching the parents of a child who is being treated
in clinic for otitis media. Which of the following statements is
essential to include in the teaching?
a. “Do not take acetaminophen as this is contraindicated” c. “Do
not apply heat to the ear”
b. “Take the medication until the pain and fever are gone” d.
“Take all of the medication as ordered”
46. The nurse is assessing a newborn 5 minutes after birth. He has
full flexion of the extremities, is acrocyanotic, has
a heart rate of 124, a full, lust cry, and resists the suction catheter.
The nurse should record the Apgar score as:
a. 6 b. 7 c. 8 d. 9
47. The mother of a newborn learns that her infant son has lost 8 oz
since birth 2 days ago. The nurse explains that this weight loss is
normal. What explanation will the nurse provide for the weight loss
result?
a. Feeding infants every 4 hours instead of every 3 hours c. Limited
food intake since birth
b. Loss of fluid from the cord stump d. Regurgitation of feedings
48. A 4-week-old premature infant has been receiving epoetin alfa
(Epogen) for the last three weeks. Which
assessment finding indicates to the nurse that the drug is effective?
a. Slowly increasing urinary output over the last week. c.
Changes in apical heart rate from the 180s to the 140s.
b. Respiratory rate changes from the 40s to the 60s. d. Change
in indirect bilirubin from 12 mg/dl to 8 mg/dl.
49. Immediately after birth a newborn infant is suctioned, dried, and
placed under a radiant warmer. The infant has spontaneous
respirations and the nurse assesses an apical heart rate of 80
beats/minute and respirations of 20 breaths/minute. What action
should the nurse perform next?
a. Initiate positive pressure ventilation. c. Initiate CPR on the
infant.
b. Intervene after the one minute Apgar is assessed. d. Assess the
infant's blood glucose level.
50. A newborn, whose mother is HIV positive, is scheduled for
follow-up assessments. The nurse knows that the most likely
presenting symptom for a pediatric client with AIDS is:
a. Shortness of breath b. Joint pain c. A persistent cold
d. Organomegaly
51. The nurse in a well baby clinic is assessing a 12-month old child.
He is 30 inches tall and weighs 30 lb. His birth weight is 8 lbs. How
does the nurse interpret this data?
a. Normal height, increased weight c. Small for age, normal weight
b. Normal height, decreased weight d. Tall for age, but weight
appropriate for height
52. The mother of an infant who has had a cleft lip repair has been
taught the postoperative care needed. What does the nurse hope to
see when evaluating this mother’s understanding of this care?
a. Positioning the child on his abdomen to facilitate drainage of oral
secretions
b. Comforting the child as soon as he starts to fuss, to prevent his
crying
c. Using a regular bottle nipple to feed the infant in a semi-reclining
position
d. Cleaning the suture line with warm water and washcloth once a
day
SITUATION: Because pregnancy is a physiologic process, the health
sector aims to make pregnancy for the women and gestation for the
fetus as safe and medically uneventful as far as possible.
53. The 2000 Philippine Health Statistics revealed that the main
cause of reported maternal deaths is due to:
a. Postpartum hemorrhage b. Pregnancy with abortive outcomes
c. Hypertension d. None of the above
54. Every woman has the right to visit the nearest health care facility
for antenatal registration and to avail prenatal care services. How
often should the expectant mother visit the health center when she
is on her 8th month of
pregnancy?
a. Every other day after the 8th month of pregnancy till delivery
b. Every week after the 8th month of pregnancy till delivery
c. Every 2 weeks after the 8th month of pregnancy till delivery
d. None of the above
55. Tetanus toxoid vaccination is important for pregnant women and
child bearing women to prevent them and their baby from acquiring
tetanus. How many doses of Tetanus Toxoid vaccine should be given
to the mother in order to
protect the baby from acquiring neonatal tetanus?
a. One dose b. Two doses c. Three doses d. Four doses
56. How many doses of Tetanus Toxoid vaccine are needed to
protect a mother and her baby against the disease, during her
pregnancy and for lifetime immunity?
a. Three doses b. Four doses c. Five doses d. Six doses
57. Micronutrient supplementation is vital for pregnant women. To
prevent Vitamin A deficiency, pregnant women should receive
vitamin A 10,000 IU starting:
a. First trimester c. 2 weeks before delivery
b. Second trimester onwards d. 1 month after delievry
58. A pregnant woman with hypertension is suffering from
postpartum hemorrhage. The following are the first aid
measures to be done by the community health nurse, except:
a. Massage uterus and expel clots
b. Give Ergometrine 0.2 mg IM and another dose after 15 minutes
c. Place cupped palmed hands on the uterine fundus and feel for the
state of contraction
d. Apply bimanual uterine compression if postpartum bleeding still
persists
59. The community health nurse should give supportive care to the
pregnant mother during labor. The nurse should do the following,
except:
a. Encourage the mother to take a bath during the onset of labor
b. Encourage the mother to drink and eat when she feels hungry
c. Remind the mother to empty the bladder every 2 hours
d. Encourage the mother to do breathing exercises for her to have
energy in pushing the baby out of her birth canal.
60. The nurse should assess the progress of labor. She knows that
the pregnant woman is in false labor if:
a. The cervix is dilated 4 cm c. The membranes are not ruptured
b. There is an increase in contractions d. All of the above
61. The community health nurse should counsel the mother on the
recommended schedule of her first postpartum visit, which is:
a. 3-5 days after delivery b. 6 weeks after delivery c. A day after
delivery d. 3 weeks after delivery
62. During family planning counseling sessions, the nurse should
include which topic in the discussion?
a. Birth control methods b. Birth spacing c. Ideal number of
children d. All of the above
63. It is the nurse’s responsibility to give the couple enough
information about the different methods of contraception. What are
the factors that should be considered in method selection?
a. The age of the woman c. The effectiveness of a method
b. The woman's reproductive stage d. All of the above
64. A population pyramid is a graphical illustration that shows the
distribution of various age groups in a human population which
normally forms the shape of a pyramid. A population pyramid with a
broad base indicates:
a. Higher proportion of children and a low proportion of older
people
b. Higher proportion of older people and a low proportion of
children
c. Higher female populations
d. Higher male populations
65. A mother who wishes to use Lactation Amenorrhea method as a
form of family planning method should be instructed:
a. To use other forms of FP methods after 3 months
b. About the potential side effects
c. To wait for at least 1 month to be more effective as a FP method
d. Alternate breastfeeding with formula feeding to be more effective
66. In providing guidance for a couple wishing to avoid pregnancy,
the nurse reviews the record of a client who has a
normal 29-day cycle. On which of the following days would the
nurse expect the client to ovulate?
a. Day 5 or 6 b. Day 13 or 14 c. Day 15 or 16 d. Day 28 or 29
67. A client who is taking oral contraceptives should immediately
report which symptom associated with the adverse effect of OC’s?
a. Blurred vision b. Nausea c. Breakthrough bleeding d. Breast
tenderness
68. A mother asks Nurse Basyang about subcutaneous implants and
how long will the implants be effective. Her best response is:
a. “It is effective for one month” c. “It is effective for up to 5
years”
b. “It is effective for twelve months” d. “It is effective for ten
years”
69. A client who gave birth to a healthy 8 pound infant 3 hours ago is
admitted to the postpartum unit. Which nursing plan is best in
assisting this mother to bond with her newborn infant?
a. Encourage the mother to provide total care for her infant. b.
Provide privacy so the mother can develop a relationship with the
infant.
c. Encourage the father to provide most of the infant's care during
hospitalization.
d. Meet the mother's physical needs and demonstrate warmth
toward the infant.
70. Which maternal behavior is the nurse most likely to see when a
new mother receives her infant for the first time?
a. She eagerly reaches for the infant, undresses the infant, and
examines the infant completely.
b. Her arms and hands receive the infant and she then traces the
infant's profile with her fingertips.
c. Her arms and hands receive the infant and she then cuddles the
infant to her own body.
d. She eagerly reaches for the infant and then holds the infant close
to her own body.
71. A client who is attending antepartum classes asks the nurse why
her healthcare provider has prescribed iron tablets. The nurse's
response is based on what knowledge?
a. Supplementary iron is more efficiently utilized during pregnancy.
b. It is difficult to consume 18 mg of additional iron by diet alone.
c. Iron absorption is decreased in the GI tract during pregnancy.
d. Iron is needed to prevent megaloblastic anemia in the last
trimester.
72. When educating a pregnant client about home safety, which of
the following information is least appropriate for the nurse to
include in the teaching plan?
a. When taking a shower, place a non-skid mat on the floor of the
tub or shower.
b. Avoid climbing stairs
c. Avoid wearing high heels.
d. Use non-slip rugs on the floors.
73. A woman comes to the health clinic because she thinks she is
pregnant. Tests are performed and the pregnancy is confirmed. The
client’s last menstrual period began on September 8 and lasted for 6
days. The nurse calculates that
her expected date of confinement (EDC) is:
a. May 15 b. June 15 c. June 21 d. July 8
74. A woman comes to the clinic for routine prenatal check-up at 34
weeks’ gestation. Abdominal palpation reveals the fetal position as
right occipital anterior (ROA). At which of the following sites would
the nurse expect to find the
fetal heart tone?
a. Below the umbilicus, on the mother’s left side c. Above the
umbilicus, on the mother’s left side
b. Below the umbilicus, on the mother’s right side d. Above the
umbilicus, on the mother’s right side
75. Mrs. Dimaano complains about her morning sickness. The nurse
provides health teachings to the client. Which of the following
statements made by the client indicates a need for further
instruction by the nurse? a. “ I will avoid spicy or fatty foods”
“I will eat small frequent meals”
b. “ I will postpone eating until supper” d. “I will eat crackers and
dry toast before arising”
76. Nurse Mian is preparing to assist in performing Leopold’s
maneuver to a pregnant client. Which of the following should the
nurse include in preparing the client for this procedure?
a. Tell the client to drink a glass of water before the procedure
b. Locate the fetal heart tones
c. Tell the client to void before beginning the examination
d. Advise the client not to eat anything 4 hours before the exam
77. Mrs. Makiss is scheduled for a nonstress test. After the test, the
result documented on the chart is no accelerations during the 40
minute observation. The nurse interprets these findings as:
a. A reactive stress test c. An unsatisfactory stress test
b. A nonreactive stress test d. The results are inconclusive
78. Another client had a nonstress tests for the past few weeks and
the results were reactive. A few minutes ago, the results were
nonreactive. The nurse anticipates that the client will be prepared
for:
a. A return appointment in 2 to 7 days to repeat the nonstress test
b. A contraction stress test
c. Hospital admission with continuous fetal monitoring
d. Immediate induction of labor
79. A pregnant woman is having a contraction stress test (CST)
preformed. Which of the following shows a negative test result?
a. 50% or more contractions cause a late deceleration
b. No FHR decelerations occur with contractions
c. Decrease in FHR that occurs toward the end of a contraction and
continues after the contraction
d. All of the options indicate a negative result
80. During her first trimester, a woman experiences many
physiologic changes that lead her to think she is pregnant.
Which of the following changes will the nurse likely tell her are
normal changes for an 8 week pregnancy?
a. Dysuria b. Colostrum secretion c. Nosebleeds d.
Dependent edema
81. Following her baby’s birth, the woman’s uterine fundus is soft,
midline, 2 cm above the umbilicus, and she has saturated two pads
within 30 minutes. Which immediate need by the client should be
addressed?
a. Be cleaned and have another pad change c. Have an increase
in her IV fluids of Ringer’s Lactate
b. Empty her bladder d. Have her fundus massaged
82. Nurse Junifer is caring for a woman who is having labor induced
with an oxytocin (Pitocin) drip. Which assessment of the client
indicates there is a problem?
a. The fetal heart rate is 160 beats per minute c. Contraction
duration is 60 seconds
b. The woman has three contractions in 5 minutes d. Early fetal
rate decelerations are occurring
c.
83. Mrs. Fortalejo is in labor and taking three cleansing breaths
followed by four, slow, deep breaths with each contraction. She is
experiencing much discomfort with her contractions. What action is
most appropriate for the nurse to take?
a. Demonstrate to Mrs. Fortalejo a different breathing pattern
during contractions
b. Ask the physician for an order of pain medication
c. Have the man take a break and instruct Mrs. Fortalejo in another
breathing pattern
d. Leave the couple alone as they have their routine established
84. Nurse Kristine is teaching childbirth education classes. What
topic should be included during the second trimester?
a. Overview of the conception c. Infant care
b. Medication and breastfeeding d. Strategies to relieve the
discomforts of pregnancy
85. Nurse Esther is caring for a woman in labor who suddenly
complains of dizziness, becomes pale, and has a 30-point drop in her
BP with an increase in pulse rate. What is the most appropriate
initial nursing action?
a. Turn her to her left side c. Notify her physician
b. Have her breathe into a paper bag d. Increase her IV fluids
86. A woman is 25% over her ideal weight of 140 pounds. She would
like to lose weight before becoming pregnant. The woman is 2
months into her weight loss program. Which indicates she is
following proper weight management
principles?
a. Carefully selects only carbohydrate and fat choices for meals
b. Has lost a total of 4 pounds
c. Is now 5% over her ideal weight
d. Goes to beginning aerobics for three times a week
87. A 38-week primigravida who works as a secretary and sits at a
computer 8 hours each day tells the nurse that her feet have begun
to swell. Which instruction would be most effective in preventing
pooling of blood in the lower extremities?
a. Wear support stockings c. Move about every hour
b. Reduce salt in her diet d. Avoid constrictive clothing
88. A client receiving epidural anesthesia begins to experience
nausea and becomes pale and clammy. What intervention should
the nurse implement first?
a. Raise the foot of the bed c. Evaluate the fetal heart rate
b. Assess for vaginal bleeding d. Take the client's blood pressure
89. A 37-week gestation neonate has just been born to a woman
with insulin-dependent diabetes mellitus and is admitted to the
nursery. Which of the following is most essential when planning
immediate care for the infant?
a. Glucose monitoring b. Daily weights c. Supplemental formula
feedings d. An apnea monitor
97. A woman with severe PIH was delivered 2 hours ago. Which
nursing action should be included in the plan of care for her
postpartum hospital stay?
a. Continuing to monitor blood pressure, respirations and reflexes
b. Encouraging frequent family visits c. Keeping her NPO
d. Maintain an IV access to the circulatory system

90. A 34 week pregnant client calls the clinic complaining of severe
headache, blurred vision, and swollen feet. The nurse expects the
physician to tell the client to:
a. Have it checked in the hospital b. Come to the clinic tomorrow
morning
c. Decrease salt intake and increase fluids
d. Rest for 4 hours a day for 3 days and come to the clinic if
symptoms persist
98. Discharge instructions are given to a woman who had been
admitted with placenta previa. Which statement by the client to her
husband best demonstrates she understands the teaching?
a. “We can’t have sex”
b. “I have to return in a few days for a vaginal exam”
c. “I will have to have a caesarian delivery for this and other
pregnancies”
d. “I can go back to part-time work beginning tomorrow”

91. Nurse Grasya went to give her morning care to a postpartum
mother, she observed the mother talking to the baby, checking
diaper, and asking infant care questions. Nurse Grasya determines
that the client is in which postpartal phase of psychological
adaptation?
a. Taking in
b. Taking on
c. Taking hold
d. Letting go
92. During an initial prenatal visit a pregnant client states she has
had 2 miscarriages at 12 weeks and 13 weeks, one child delivered at
38 weeks, and another child delivered at 40 weeks. The nurse
documents this as:
a. G4P2/T2A2 b. G3P3/T2A1 c. G3P2/T2A2 d. G4P3/T3A0
93. A woman who is 24-hours postpartum and who has an
episiotomy would be instructed to report which of the following
findings immediately?
a. Decrease in urine output c. Presence of lochia rubra
b. Absence of a daily bowel movement d. Increase in perineal pain
sensation
99. The nurse is caring for a woman who is 35 weeks pregnant. She
comes to the emergency room with painless, vaginal bleeding. This
is her third pregnancy and she states that this has never happened
before. What would be avoided in caring for this client?
a. Allowing her husband to stay with her c. Shaving the perineum
b. Keeping her at rest d. Performing vaginal examination
100. Nurse Hannah is caring for a woman with a placenta previa who
has been hospitalized for several weeks. She is now at 38 weeks’
gestation and her membranes have ruptured. The amniotic fluid has
a greenish color and the woman has started to bleed again. What
would the nurse’s first action?
a. Administer oxygen
b. Place her in trendelenburg’s position
c. Call the doctor and prepare for a cesarian birth
d. Move her to the delivery room immediately

94. A client in active labor is admitted with preeclampsia. Which

assessment finding is most significant in planning this client's care?
a. Patellar reflex 4+. c. Four-hour urine output 240 ml.
b. Blood pressure 158/80. d. Respiration 12/minute.

95. When explaining "postpartum blues" to a client who is 1 day

postpartum, which symptoms should the nurse include in the
teaching plan?
1. Mood swings 3. Tearfulness 5. Disinterest in the infant
2. Panic attacks 4. Decreased need for sleep
a. 1 and 3 b. 1, 3, 4 c. All except 2 d. All of the above

96. A primigravida client with severe preeclampsia is receiving

magnesium sulfate via continuous IV infusion. Which assessment
data indicates to the nurse that the client is experiencing
magnesium sulfate toxicity?
a. Deep tendon reflexes 2+. c. Respiratory rate 18/minute.
b. Blood pressure 140/90. d. Urine output 90 ml/4 hours.